Using Insurance for Acupuncture: What You Need to Know

If you’re considering acupuncture but wondering whether your insurance will cover it, you’re not alone. Many patients are unsure how acupuncture benefits work, what’s covered, and how to navigate insurance claims. This guide will answer common questions about using insurance for acupuncture, including coverage eligibility, deductibles, superbills, and tips to maximize your benefits.

Does Insurance Cover Acupuncture?

Acupuncture insurance coverage varies depending on your health plan. A provider listed as in-network does not necessarily mean that your specific plan covers their services. Some insurance providers include acupuncture under their policies, while others may only cover specific conditions being treated, such as:

• Chronic or low back pain (sometimes related to only a specific area)

• Migraines and headaches

• Postoperative nausea or nausea related to pregnancy

• Osteoarthritis

• Sciatica

To find out if your plan covers acupuncture and if there are limits to what conditions your plan may cover, check your benefits online or call your insurance provider directly. We are currently in-network with Blue Cross Blue Shield of Illinois, Cigna, and Aetna and can verify your insurance coverage before your visit. 

How to Check If Your Insurance Covers Acupuncture

1. Log in to Your Insurance Portal or Call Your Insurance Provider – Ask a representative if acupuncture is covered, what conditions are eligible, and whether you need a referral. You can also search “acupuncture” through your online insurance portal.

2. Ask Your Acupuncture Clinic – We offer insurance verification services and can confirm your benefits for you.

Understanding Deductibles and Copays for Acupuncture

Even if your insurance covers acupuncture, you may have out-of-pocket costs, such as:

• Deductible: The amount you must pay before insurance starts covering services. If your plan has a $1,000 deductible and you haven’t met it yet, you’ll pay out of pocket until you reach that amount. The trick with a deductible is that you need to understand what in your plan can be paid towards your max number. For example, payments you make for some pharmaceuticals or medical services will NOT count as payments towards your deductible.

• Copay: A fixed amount (e.g., $20-$50 per visit) you pay for each acupuncture session. Depending on your plan, these payments might count towards your deductible or not.

• Coinsurance: A percentage of the service cost you must pay after meeting your deductible (e.g., 20% of each session). This is a percentage of the charges which your provider sends to insurance, so that price can vary based on what is being charged each treatment.

What is a Superbill and How Does It Work?

If we are out-of-network for your plan or if you do not have acupuncture coverage, you may need to submit a superbill to your insurance for reimbursement. A superbill is a detailed invoice that includes:

• Your diagnosis and treatment codes

• Date of service

• Provider information

• Total cost of treatment

To use a superbill:

1. Pay for your acupuncture session upfront

2. Request a superbill from us

3. Submit the superbill to your insurance company

4. Receive reimbursement (if your plan allows it)

Check your out-of-network benefits to see what percentage of the cost your insurance might cover. Please note, us providing a superbill is not a guarantee that you will receive reimbursement from your insurance provider. It would be up to you to follow up with them for any reimbursement options.

Does Medicare or Medicaid Cover Acupuncture?

• Medicare: Covers acupuncture for chronic low back pain under certain conditions, but not for other conditions. We are currently not in-network with Medicare.

• Medicaid: Coverage varies by state. Some Medicaid programs cover acupuncture for pain management, substance use disorders, and other medical conditions. We are currently not in-network with Medicaid.

Tips for Maximizing Your Acupuncture Insurance Benefits

• Verify benefits before booking an appointment. This prevents unexpected costs. You will receive a link to our insurance eligibility form with confirmation of your new patient appointment.

• Use an in-network provider (if possible) to lower out-of-pocket expenses. We are currently in-network with BCBS IL, Cigna, and Aetna.

• Track your visits to stay within annual session limits. Some plans cap acupuncture visits per year. We can work with you to schedule a treatment plan that would best work with your visit limits.

• Save all superbill receipts for reimbursement or tax deductions.

Find Out if Your Insurance Covers Acupuncture

If you’re unsure about your acupuncture benefits, contact your insurance provider or reach out to us. We can help verify your insurance and explain your options so you can get the care you need.

Need Help with Insurance for Acupuncture?

Book a consultation today and let us guide you through the process!